氯氮平、利培酮及奥氮平对首发精神分裂症患者血清脂类的影响

目的探讨氯氮平、利培酮及奥氮平对首发精神分裂症患者血脂的影响。方法选择在我院治疗的首发精神分裂症患者90例,并分为3个月,每组各30例,分别单一用氯氮平、利培酮及奥氮平治疗。于治疗前、治疗第4周末和第8周末检测甘油三酯、胆固醇及脂蛋白。结果氯氮平、奥氮平组治疗第4周末、8周末甘油三酯值与治疗前有显著差异。氯氮平与奥氮平组治疗第8周末甘油三酯有显著差异。氯氮平组治疗第8周末低密度、高密度脂蛋白与治疗前有显著差异。奥氮平组治疗第8周末低密度脂蛋白与治疗前有显著差异。利培酮组治疗前后无显著差异。结论氯氮平对精神分裂症血脂影响最大,其次是奥氮平,最小是利培酮。对服用氯氮平和奥氮平的患者应定期监测血脂。     

利培酮、氯丙嗪对精神分裂症患者血清甘油三酯浓度的影响

本文着重探讨了利培酮和氯丙嗪对精神分裂症患者血清甘油三酯（TG）浓度的影响,并将结果报道于后。     

利培酮对氯氮平血浓度影响的初步研究

目的：了解利培酮对氯氮平血浓度的影响。方法：11例精神分裂症人,单用氯氮平2周后并用利培酮3月,分别测定药前后氯氮平血药浓度,进行自身配对比较分析。结果,加利培酮后,平均氯氮平血浓度和平均N－去甲氯氮平血浓度升高（后者P＜0．05）,单用氯氮平和并用利培酮时,N－去甲氯氮平血浓度与氯氮平浓度呈正相关（P均＜0．01）。结论：利培酮可使氯氮平血浓度升高,如氯氮平剂量偏高时,并利用培酮,有增加氯氮平药物毒副反应的潜在危险性。     

脑卒中急性期患者血清Leptin水平及其相关性研究

目的 研究脑卒中急性期患者血清Leptin(瘦素)水平及与血压、血清胰岛素、血糖、血脂的关系。方法用放射免疫分析法测定183例急性脑血管病患者血清Leptin水平,其中脑梗死119例(男65例,女54例),脑出血64例(男41例,女23例),并同时测定空腹血糖、血清胰岛素、血脂,且与137例健康体检者进行对照。结果 男性脑梗死及脑出血患者的Leptin水平高于男性对照组(P<0.01),且以男性脑出血患者增高更明显。女性脑出血组的Leptin水平高于女性对照组(P<0.01)。脑出血急性期患者血清Leptin水平与血糖呈正相关(r=0.48,P<0.01),与血清胰岛素呈正相关(r=0.58,P<0.01),与血压呈正相关(r=0.37,P<0.05),与高密度脂蛋白呈负相关(r=-0.38,P<0.01)。急性脑梗死患者血清Leptin水平与血清胰岛素呈正相关(r=0.47,P<0.01),与高密度脂蛋白呈负相关(r=-0.30,P<0.05。结论 急性脑血管病患者血清Leptin水平升高,是神经内分泌功能紊乱的表现,是脑出血急性期患者的危险因素之一。     

氯氮平、氯丙嗪对精神分裂症患者血清胆碱酯酶活力影响的研究

目的 探讨氯氮平、氯丙嗪对血清胆碱酯酶活力的影响。方法 设氯氮平、氯丙嗪两研究组和正常对照组各30例,研究组分别于治疗前、治疗后1、2、3、4周测血清胆碱酯酶活力及采用简明精神病评定量表（BPRS）、不良反应症状量表（TESS）评定临床症状。对照组测血清胆碱酯酶一次。结果 两研究组治疗前血清胆碱酯酶活力与对照组比较,均有显著性差异（t值分别为2.4661、3.0557,P<0.02及P<0.005）。氯氮平组治疗前、后各周血清胆碱酯酶活力相比较,均有显著性差异（t值分别为2.1861、2.7199、3.0109、3.1190、P<0.05～0.005）;氯丙嗪组治疗前、后各周均无显著性差异。结论 提示精神分裂症患者体内可能存在血清胆碱酯酶活力的代谢异常。氯氮平、氯丙嗪治疗对血清胆碱酯酶活力有不同影响,可能与药理作用不同有关。     

氯氮平与氯丙嗪对精神分裂症患者血清唾液酸的影响

目的 比较氯氮平和氯丙嗪对血清唾液酸的影响。方法 用间苯二酚快速测定法分别检测30例服用氯氮平和32例服用氯丙嗪的精神分裂症患者治疗前、后1、2、3、4、5周末血清唾液酸含量。结果 氯氮平治疗后血清唾液酸含量显著升高(P<0.05),氯丙嗪对血清唾液酸含量影响不明显。结论 氯氮平和氯丙嗪对唾液酸有不同的影响,氯氮平可能通过应激反应而致使血清唾液酸含量增高。     

Leptin与抗精神病药物所致的增重反应研究

体重增加(weight gain)是抗精神病药物的主要副反应之一,非典型抗精神病药如氯氮平所致体重增加高于其它典型抗精神病药物。研究者们虽有种种猜测,但机制仍不甚明了。有学者认为可能与饱食感受方面的改变、食欲亢进及碳水化合物摄入增多等引起。还有一些研究者发现氯氮平增重反应与临床疗效显著性相关:体重增加与BPRS改善呈正相关、尤其是阳性症状分数方面。这可能由于氯氮平的抗精神病药理的作用在中枢神经系统的表现。近年来,肥胖的分子生物学研究已有很大进展,尤其Leptin的发现为抗精神病药所致增重反应机理的揭示提供了一线曙光。 Leptin是1994年被发现的,它由肥胖相关基因(ob)编码,主要由脂肪组织分泌的蛋白质类激素,由167个氨基酸组成,分子量为16kd,它目前被认为通过影响食欲和能量代     

脑血管疾病急性期血清Leptin和胰岛素的含量测定及意义

目的 探讨脑血管疾病急性期(包括脑出血和脑梗死)血清Leptin和胰岛素的含量变化及临床意义。方法 选取脑出血急性期患者30例(男16,女14),脑梗死急性期患者30例(男15,女15)和正常对照30例(男15,女15),应用放射免疫血方法检测各组血清Leptin和胰岛素的含量。结果 在脑出血组,血清Leptin[男性(5.94±1.50)ng/ml,女性(14.30±5.20)ng/ml]比正常对照组[男性(3.49±1.20)ng/ml,女性(7.45±2.32)ng/ml]显著增高(P<0.001);而在脑梗死组血清Leptin水平与正常对照组之间差异无显著性。在脑梗死组血清胰岛素水平[(18.20±5.37)μIU/ml]比正常对照组[(15.56±3.28)μIU/ml]明显增高(P<0.05);而在脑出血组,这种差异无显著性。在脑出 血和脑梗死组,血清Leptin和胰岛素水平呈正相关(脑出血组P<0.001,脑梗死组P<0.001)。结论 本研究结果提示,高Leptin血症可作为脑出血发生的重要危险因素之一,而高胰岛素血症可作为脑梗死发生的重要危险因素之一。脑血管疾病急性期,血清Leptin和胰岛素均高于正常对照组,并且血清Leptin和胰岛素呈正相关,提示了二者在脑血管疾病发生中发挥了重要作用。     

氯氮平治疗对精神病患者血糖、血清C-肽浓度的影响

国外有文献表明,氯氮平可使血清葡萄糖、C-肽水平升高。我们对精神病患者服用氯氮平前后空腹血糖、血清C-肽水平的变化进行了研究,旨在验证上述结论。现报道于后。     

氯氮平与利培酮对精神分裂症患者体重增加影响的研究

目的探讨新型抗精神病药氯氟平与利培酮对精神分裂症患者体重的影响。方法将60例精神分裂症病人随机分为氯氯平组和利培酮组各30例,对所有患者在用药前、4周和8周时测体重、身高＋计算Quetelet指数,分析其变化。结果氯氮平组体重指数增加明显,治疗前后差异有显著性意义（P〈0．05）。结论氯氯平易导致体重增加,利培酮对体重影响较轻,治疗期间应对使用氯氯平的患者做好饮食指导。     

A prospective study of serum ghrelin levels in patients treated with clozapine

Summary. We investigated serum ghrelin levels (SGL) in 12 patients with schizophrenia over a 10-week period after initiation of clozapine treatment. In contrast to increments of body mass indices (BMI, kg/m²) and serum leptin levels (SLL), no significant change in SGL was detected. Inverse correlations between delta SGL and delta SLL did not reach statistical significance. Linear mixed model analysis could not detect effects of age, sex, BMI, SLL and serum clozapine levels on SGL. Our results do not support a causal involvement of ghrelin in clozapine-related weight gain.     

利培酮和氯氮平对体重及血脂影响的对照分析

目的：比较利培酮与氯氮平对体重及血脂的影响。方法：对单服利培酮或氯氮平的精神分裂症患者于用药前后测定体重有所增加但无持续升高趋势,血脂水平无明显变化。服用氯氮平后体重、甘油三脂（ＴＧ）及女性胆固醇（Ｔｃｈ）于第４周即明显增加且体重有逐渐升高趋势。结论：利培酮与氯氮平均可导致体重增加,而利培酮对体重增加无持续升高趋势且较氯氮平对血脂的影响为小。     

Weight gain associated with clozapine,olanzapine and risperidone in children and adolescents

Summary. The study was aimed at the evaluation of weight gain associated with atypical antipsychotics and its clinical risk factors in children and adolescents. Weight and body mass index (BMI) of initially hospitalised patients treated with clozapine (n = 15), olanzapine (n = 15), and risperidone (n = 15) were prospectively monitored on a weekly basis for the first 6 weeks. Different clinical risk factors were tested for their association with weight gain in the three groups. All three groups experienced significant weight gain between baseline and endpoint (p < 0.0001). For all weight measures, planned comparisons were all significant between olanzapine vs. clozapine and risperidone, respectively. Average weight gain was significantly higher for the olanzapine group (mean = 4.6 kg, SD = 1.9) than for the risperidone (mean = 2.8 kg, SD = 1.3) and clozapine (mean = 2.5 kg, SD = 2.9) groups. Olanzapine and risperidone, but not clozapine, caused a disproportionately higher weight gain in children and adolescents in comparison to adults.     

首发抑郁症血清褪黑激素水平的初步研究

目的　检测首发抑郁症发作时 ,使用SSRI类抗抑郁剂后的褪黑激素水平 ,并探讨用放免作为测定抑郁症褪黑激素水平有效方法的可能性。方法　对 18例首发抑郁症、13例首发精神分裂症和 17例正常志愿者采用放射免疫法检测其血清褪黑激素水平。结果　首发抑郁症抑郁发作时血清褪黑激素水平显著低于对照首发精神分裂症组 ,治疗后血清褪黑激素水平有显著升高。结论　褪黑激素在抑郁症的发病机制中起一定作用 ,放免法测定褪黑激素水平是良好的     

High serum leptin levels in depressive disorders with atypical features

Leptin is thought to be related to vegetative symptoms of depression such as alterations in food intake and weight. Fifty-seven drug-free patients and 26 healthy controls were enrolled in this study. We have found that the serum leptin levels were higher in patients with atypical depressive disorder than in controls, but not in patients with non-atypical depressive disorder, however, body mass index, age, and gender were not significantly different between these groups. Probably, these findings seem to be associated with some features of the atypical depressive disorders such as weight gain, a result of hyperphagia.     

The effect of carbamazepine treatment on serum leptin levels

Patients with epilepsy may manifest metabolic adverse effects throughout the course of their management with antiepileptic drugs. Leptin is a hormone that plays a major role in the regulation of feeding and energy expenditure. Leptin has been expected to form a link to weight gain in epilepsy with the use of some antiepileptic drugs. The aim of this study is to evaluate the effect of carbamazepine on body weight and serum leptin levels.This study was conducted in Izmir Tepecik Training and Research Hospital, Neurology Department. 56 epileptic patients who were on continuous carbamazepine monotherapy for at least 6 months before the study and 42 control subjects were included. Serum leptin and insulin levels were measured.Body mass index, leptin and insulin were not significantly elevated in carbamazepine group compared to control subjects (p > 0.05).Our study demonstrated that carbamazepine therapy does not affect significantly body mass index, leptin and insulin. Data regarding the effect of carbamazepine on serum leptin level is limited but the results of these recent studies are correlated with ours. It can be concluded that carbamazepine is a relatively low risky antiepileptic drug in terms of obesity and metabolic syndrome but further studies are needed.     

Metabolic disturbances associated with antipsychotic drug treatment in patients with schizophrenia: State-of-the-art and future perspectives

Metabolic disturbances and obesity are major cardiovascular risk factors in patients with schizophrenia, resulting in a higher mortality rate and shorter life expectancy compared with those in the general population. Although schizophrenia and metabolic disturbances may share certain genetic or pathobiological risks, antipsychotics, particularly those of second generation, may further increase the risk of weight gain and metabolic disturbances in patients with schizophrenia. This review included articles on weight gain and metabolic disturbances related to antipsychotics and their mechanisms, monitoring guidelines, and interventions. Nearly all antipsychotics are associated with weight gain, but the degree of the weight gain varies considerably. Although certain neurotransmitter receptor-binding affinities and hormones are correlated with weight gain and specific metabolic abnormalities, the precise mechanisms underlying antipsychotic-induced weight gain and metabolic disturbances remain unclear. Emerging evidence indicates the role of genetic polymorphisms associated with antipsychotic-induced weight gain and antipsychotic-induced metabolic disturbances. Although many guidelines for screening and monitoring antipsychotic-induced metabolic disturbances have been developed, they are not routinely implemented in clinical care. Numerous studies have also investigated strategies for managing antipsychotic-induced metabolic disturbances. Thus, patients and their caregivers must be educated and motivated to pursue a healthier life through smoking cessation and dietary and physical activity programs. If lifestyle intervention fails, switching to another antipsychotic drug with a lower metabolic risk or adding adjunctive medication to mitigate weight gain should be considered. Antipsychotic medications are essential for schizophrenia treatment, hence clinicians should monitor and manage the resulting weight gain and metabolic disturbances.     

氯氮平与利培酮对血清催乳素水平的影响

目的：了解氯氮平或利培酮对首发女性精神分裂症患者血清催乳素水平的变化,方法：采用ELISA方法制定血清催乳素水平,结果：治疗后氯氮平组血清催乳素水平没有显著变化。而利培酮组血清催乳素水平显著升高。结论催乳素水平不能说明精神分裂症发病及严重程度,也不能作为非典型抗精神病药疗效的指标。     

首发精神分裂症患者利培酮治疗前后血浆瘦素和白细胞介素-6的研究

目的探讨精神分裂症患者利培酮治疗前后血浆瘦素和白细胞介素-6(IL6)水平的变化及意义。方法患者组为65例首发的精神分裂症患者,利培酮治疗前和治疗8周后分别测量身高、体重以计算体质量指数,用放射免疫方法检测其空腹血浆瘦素和IL6。选取52名健康人作为对照组进行比较。结果治疗后患者组体质量指数、血浆瘦素水平均明显上升,与治疗前比较差异有显著性(P均小于0.05);患者组血浆IL6水平在治疗前与对照组相比明显增高,治疗后明显下降,与治疗前比较差异有显著性(P均小于0.05);治疗前后血浆瘦素的差值和IL6的差值呈负相关(r=-0.388,P<0.05)。结论首发精神分裂症患者血浆IL6水平高于对照组,服用利培酮治疗容易出现药源性肥胖,增高的IL6水平可能是瘦素抵抗的原因之一;过高的瘦素水平与IL6之间可能存在负反馈。     

利培酮与氯氮平对精神分裂症患者认知功能影响的对照研究

目的：观察利培酮与氯氮平对精神分裂症患者认知功能的影响。方法：将80例精神分裂症住院患者随机分为两组,并分别予以利培酮与氯氮平治疗12周,于入组前及治疗结束时测查威斯康星卡片分类测验,韦氏记忆测验,阳性和阴性症状量表,并与正常人比较,借以分析两药对认知功能的影响。结果：两组间在威斯康星卡片分类测验,韦氏记忆测验,阳性和阴性症状量表中的认知因子分上并无显著性差异,治疗前后比较利培酮组（40例）在记忆,阳性和阴性症状量表中的认知因子分及威斯康星卡片分类测验中的完成分类数和概念的水平,其百分数有显著差异,而氯氮平组（33例）仅在阳性和阴性症状量表中的认知因子及威斯康星卡片分类测验中的概念水平,其百分数有显著差异,在威斯康星卡片分类测验中完成第一个分类的次数有增加趋势。结论：利培酮对认知功能障碍的治疗作用优于氯氮平。